Monday, June 15, 2009

STI: An everyday hero

June 14, 2009

An everyday hero

Injured in the spine due to a surgical accident, Jack faces life with no bitterness or self-pity

By Lee Wei Ling

My patient and friend Jack is 59 years old. For the last five years, he has suffered daily the consequences of a spinal cord injury caused by a surgical accident.

He was operated on initially because he had difficulty walking. The bony spinal canal surrounding his spinal cord had been narrowed by an overgrowth of bone and ligaments that compressed his spinal cord at the neck, hence impairing his control of the muscles at and below that level. He was operated on in an attempt to decompress the spinal cord at his neck.

Unfortunately, the surgeon who operated on him accidentally dropped a bone nibbler - yes, an ominous name for a surgical instrument which nibbles away bone - on his spinal cord, thus damaging it. The operation was aborted immediately and the incision site was closed.

When Jack woke from anaesthesia, he was totally paralysed at and below the level where his spinal cord had been traumatised.

The surgeon explained the accident to him and sincerely apologised. Jack accepted the explanation and apology and forgave the surgeon. There was never any thought of a lawsuit.

Gradually, with the help of intensive physiotherapy - not to mention his determination - Jack regained strength but not dexterity in his body and limbs. He could walk but his muscles were stiff and often went into spasms.

Walking, for him, was so difficult and slow it was painful to watch. His hand and finger movements were also affected and simple tasks like buttoning his shirt were major efforts. In addition, he suffered severe, constant pain which got worse over the years.

He is a cousin of a close friend of mine who, five years ago, asked me to see Jack for a second opinion as to how his pain might be relieved.

I saw him, traced his medical records and suggested several options to reduce the pain and stiffness. Unfortunately, all of the options involved further surgery. At that time, he declined.

Since then, about twice a year, I would ask Jack whether he could come to the National Neuroscience Institute (NNI) to function as a subject for teaching purposes. He has never refused, but he could come only after work.

I was surprised that in spite of his handicap, he could still hold down a regular job. He takes the MRT to Novena station, and then walks slowly with the help of a walking stick to the NNI's outpatient clinic.

He patiently recounts the story of his ailment to each new batch of medical students. He allows me to demonstrate his abnormal muscle tone, his sensory perception and over-active tendon reflexes to the students.

Then, he patiently allows each of the 10 students to confirm these findings. When the tutorial is over, he declines any cash reimbursement for transport and walks painfully back to Novena MRT station to head home.

As he leaves, the students and I watch the slow and painful gait of this man who suffers daily, walking away with walking stick in his hand, dragging his legs which appear too stiff and heavy to lift off the ground.

I remind my students not only of the medical ailments we have just studied, but also of the bigger lesson in life: of a man who readily forgave the surgeon whose mistake caused him lifelong suffering; of a man who faces life with no bitterness or self-pity and makes the best of the circumstances he finds himself in.

More than that, he takes the time to come to NNI so that my students can learn from him. He does it because he is a good man, and also because I am his cousin's friend and he and I are now friends.

I remind my students that the problems they whine and bitch about are minor and transient compared to the problems my patient faces, with considerable dignity and courage, daily.

If he had received his injury in the course of defending Singapore, he would have been awarded a distinguished military award. But the injury was the result of a misfortune.

The courage with which he has faced the consequences of his injury is no less inspiring than if the injury had been incurred in the line of defending Singapore, and he is a hero. I hope the students who have interacted with him have learnt something about life and how to live it.

I have certainly learnt much from my friend, the most important being to accept what we cannot change and let go of anger and bitterness, for neither will help us. In fact, they are maladaptive as they cause distress and serve no purpose.

Finally, as we are discussing a medical problem, we must constantly keep in mind new medical or surgical treatments and technology that may solve a previously untreatable condition.

NNI has sent a bright neurosurgeon to train in functional neurosurgery in Toronto. Among the skills he will bring back are the latest techniques in pain treatment. I have discussed this with Jack, whose pain has become more severe over the years.

He is keen to discuss new treatment options. Realistic hope makes suffering easier to bear and I try to offer this whenever the option is available. It is amazing how much of our suffering can be influenced by our state of mind.

The writer is director of the National Neuroscience Institute.

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